There has been a nauseating amount of discussion about physician burnout lately. An equal number of remedies, from mindfulness to exercise, to inpatient psychiatric treatment for doctors experiencing unmanageable stress and burnout. And then I read this report of a survey from the world-famous Cleveland Clinic, which describes 35% of nearly 1100 physicians employed by The Cleveland Clinic have signs of overt burnout. More importantly, those physicians who cared more about their patients had higher rates of burnout! Similarly, burnout was greater among full time employed physicians. Of course, a so-called expert suggests that the solution should be to make these really good doctors do less doctoring and involve less-skilled and less-educated people take over those duties. But nobody bothered to ask these physicians why they felt down and out.

To add salt to the wound, today brings us news that The Cleveland Clinic reported a significant increase in operating income for 2017. It is good news that their income is up. However, as the Politico pointed out, the immediate neighborhood remains mired in poverty and poor health, while The Clinic continues its prosperous ways. Despite being a “non-profit”, it has had no positive economic or health impact on its own neighborhood.

Which brings us back to the question of physician burnout. It is now known that less than half of American physicians are independent, which means a majority are now hospital-employed. This, as we know, is a risk factor for physician burnout. In addition, it is more likely that these hospital-employed docs are mandated to participate in MOC as compared those in independent practice, and as Dr. Paul Mathew points out, MOC is a major factor in physician burnout.

So let’s put all these observations together – the most dedicated, hospital-employed physicians, who care most about their patients end up suffering the worst burnout. Similarly, those communities that surround the biggest health systems seem to have the worst economic and health outcomes. Meanwhile, the same hospital systems continue to enjoy their non-profit status and leading politicians from both major parties keep referencing them as examples to emulate elsewhere.

Patients and doctors are suffering, costs continue to rise, and “non-profits’ are conglomerating and pulling in increasing incomes. Yet our political leaders are oblivious to these facts on the ground. The solution to all three major problems (patient care, physician health, healthcare costs) is obvious. Is anybody watching, listening, understanding?

About Arvind Cavale MD

Comments

‘Is anybody watching, listening, understanding?” The answer is yes, yes, they don’t care to. Money, power and control usually explain why things are the way they are. On occasion we are thrown a bone but control of medical care was lost a long time ago. It will not get better given the current structure of society. Though this issue is important to us, it is just a piece of a bigger picture.

You are correct, but our task at Rebel.MD is to ask the difficult questions and prod people for an answer. If we partner with our patients and demand control of our destiny, it is possible to turn this around.